Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts (R) total joint prostheses Part I - Skeletal and dental stability

The purpose of this study was to evaluate skeletal and dental stability in patients who had temporomandibular joint (TMJ) reconstruction and mandibular counterclockwise advancement using TMJ Concepts total join, prostheses (TMJ Concepts Inc. Ventura, CA) with maxillary osteotomies being performed at the same operation. All patients were operated at Baylor University Medical Center, Dallas TX, USA, by one surgeon (Wolford). Forty-seven females were studied; the average post-surgical follow-up was 40.6 months. Lateral cephalograms were analyzed to estimate surgical and post-surgical changes. During surgery, the occlusal plane angle decreased 14.9 +/- 8.0 degrees. The maxilla moved forward and upward. The posterior nasal spine moved downward and forward. The mandible advanced 7.9 +/- 3.5 mm at the lower incisor tips, 12.4 +/- 5.4 mm at Point B, 17.3 +/- 7.0 mm at menton, 18.4 +/- 8.5 mm at pogonion, and 11.0 +/- 5.3 mm at gonion. Vertically, the lower incisors moved upward -2.9 +/- 4.0 mm. At the longest follow-up post surgery, the maxilla showed minor horizontal changes while all mandibular measurements remained stable. TMJ reconstruction and mandibular advancement with TMJ Concepts total joint prosthesis in conjunction with maxillary osteotomies for counter-clockwise rotation of the rnaxillo-mandibular complex was a stable procedure for these patients at the longest follow-up.

Changes in cells's secretory organelles and extracellular matrix during endochondral ossification in the mandibular condyle of the growing rat

The mandibular condyle from 20-day-old rats was examined in the electron microscope with particular attention to intracellular secretory granules and extracellular matrix. Moreover, type II collagen was localized by an immunoperoxidase method. The condyle has been divided into five layers: (1) the most superficial, articular layer, (2) polymorphic cell layer, (3) flattened cell layer, (4) upper hypertrophic, and (5) lower hypertrophic cell layers. In the articular layer, the cells seldom divide, but in the polymorphic layer and upper part of the flattened cell layer, mitosis gives rise to new cells. In these layers, cells produce two types of secretory granules, usually in distinct stacks of the Golgi apparatus; type a, cylindrical granules, in which 300-nm-long threads are packed in bundles which appear lucent after formaldehyde fixation; and type b, spherical granules loaded with short, dotted filaments. The matrix is composed of thick banded lucent fibrils in a loose feltwork of short, dotted filaments. The cells arising from mitosis undergo endochondral differentiation, which begins in the lower part of the flattened cell layer and is completed in the upper hypertrophic cell layer; it is followed by gradual cell degeneration in the lower hypertrophic cell layer. The cells produce two main types of secretory granules: type b as above; and type c, ovoid granules containing 300-nm-long threads associated with short, dotted filaments. A possibly different secretory granule, type d, dense and cigar-shaped, is also produced. The matrix is composed of thin banded fibrils in a dense feltwork. In the matrix of the superficial layers, the lucency of the fibrils indicated that they were composed of collagen I, whereas the lucency of the cylindrical secretory granules suggested that they transported collagen I precursors to the matrix. Moreover, the use of ruthenium red indicated that the feltwork was composed of proteoglycan; the dotted filaments packed in spherical granules were similar to, and presumably the source of, the matrix feltwork. The superficial layers did not contain collagen II and were collectively referred to as perichondrium. In the deep layers, the ovoid secretory granules displayed collagen II antigenicity and were likely to transport precursors of this collagen to the matrix, where it appeared in the thin banded fibrils. That these granules also carried proteoglycan to the matrix was suggested by their content of short dotted filaments. Thus the deep layers contained collagen II and proteoglycan as in cartilage; they were collectively referred to as the hyaline cartilage region.

Fixation of mandibular fractures with 2.0-mm miniplates: review of 191 cases

Our goal was to study the use of 2.0-mm miniplates for the fixation of mandibular fractures. Records of 191 patients who experienced a total of 280 mandibular fractures that were treated with 2.0-mm miniplates were reviewed. One hundred twelve of those patients, presenting 160 fractures, who attended a late follow-up were also clinically evaluated. Miniplates were used in the same positions described by AO/ASIF. No intermaxillary fixation was used. All patients included had a minimum follow-up of 6 months. Demographic data, procedures, postoperative results, and complications were analyzed. Mandibular fractures occurred mainly in males (mean age, 30.3 years). Mean follow-up was 21.92 months. The main etiology was motor vehicle accident. The most common fracture was the angle fracture (28.21%). Twenty-two fractures developed infection, for an overall incidence of 7.85%. When only angle fractures are considered, that incidence is increased to 18.98%. Although only 1 patient (0.89%) described inferior alveolar nerve paresthesia, objective testing revealed sensitivity alterations in 31.52% of the patients who had fractures in regions related to the inferior alveolar nerve. Temporary mild deficit of the marginal mandibular branch was observed in 2.56% of the extraoral approaches performed and 2.48% presented with hypertrophic scars. Incidence of occlusal alterations was 4.0%. Facial asymmetry was observed in 2.67% of the patients, whereas malunion incidence was 1.78%. Fibrous union, mostly partial, occurred in 2.38% of the fractures, but only 1 of those presented with mobility (0.59%). Condylar resorption developed in 6.25% of the fixated condylar fractures. Mean mouth opening was 42.08 mm. The overall incidence of complications, including infections, was similar to those described for more rigid methods of fixation.

Clinical study on survival rate of short implants placed in the posterior mandibular region: resonance frequency analysis

Short implants are increasingly used, but there is doubt about their performance being similar to that of regular implants. The aim of this study was to compare the mechanical stability of short implants vs. regular implants placed in the edentulous posterior mandible. Twenty-three patients received a total of 48 short implants (5 × 5.5 mm and 5 × 7 mm) and 42 regular implants (4 × 10 mm and 4 × 11.5 mm) in the posterior mandible. Patients who received short implants had <10 mm of bone height measured from the bone crest to the outer wall of the mandibular canal. Resonance frequency analysis (RFA) was performed at time intervals T0 (immediately after implant placement), T1 (after 15 days), T2 (after 30 days), T3 (after 60 days), and T4 (after 90 days). The survival rate after 90 days was 87.5% for the short implants and 100% for regular implants (P < 0.05). There was no significant difference between the implants in time intervals T1, T2, T3, and T4. In T0, the RFA values of 5 × 5.5 implants were higher than values of 5 × 7 and 4 × 11.5 implants (P < 0.05). A total of six short implants that were placed in four patients were lost (three of 5 × 5.5 mm and three of 5 × 7 mm). Three lost implants started with high ISQ values, which progressively decreased. The other three lost implants started with a slightly lower ISQ value, which rose and then began to fall. Survival rate of short implants after 90 days was lower than that of regular implants. However, short implants may be considered a reasonable alternative for rehabilitation of severely resorbed mandibles with reduced height, to avoid performing bone reconstruction before implant placement. Patients need to be aware of the reduced survival rate compared with regular implants before implant placement to avoid disappointments.

Evaluation of single implants placed in the posterior mandibular area under immediate loading: a prospective study

The aim of this study was to evaluate the survival of single dental implants subjected to immediate function. Twelve patients with edentulous areas in the posterior mandible were included in the study. All received at least one regular platform dental implant (3.75mm×11mm or 3.75mm×13mm). Clinical and radiographic parameters were evaluated. The survival rate after 12 months was 83.3%. The implants showed no clinical mobility, had implant stability quotient values (ISQ; Osstell) around 70, bone loss of up to 2mm, and a probing depth of ≤3mm. Although the posterior mandible is an area in which the immediate loading of dental implants should be performed with caution, this treatment presented a good success rate in the present study sample.

Retromolar canal associated with age, side, sex, bifid mandibular canal, and accessory mental foramen in panoramic radiographs of Brazilians

Background. The retromolar canal (RMC) is an anatomical variation that can cause complications in dental procedures. Method. The RMC was evaluated according to age, sex, and presence of accessory mandibular canal and accessory mental foramen, on both sides in 500 panoramic radiographs, belonging to individuals at the age of 7 to 20 years. The associations of interest were studied through Fisher's Exact Test and Pearson's Chi-Square Test, and the correlation was studied through Pearson's Correlation Coefficient (r). The significance level used was 5%. Results. The RMC was observed in 44 radiographs (8.8%), and out of those 24 were females. There was no statistically significant association between the RMC and age (p > 0.05; Fisher's Exact Test), sex (p = 0.787; Pearson's Chi-Square Test), amount of mandibular canals and mental foramina, on both sides (p > 0.05; Pearson's Chi-Square Test). There was a significant association between RMC and side, the higher frequency of the canal being on the right side (p < 0.05; Fisher's Exact Test). Conclusions. Despite the low occurrence of the RMC, its identification and the verification of its dimensions and path are relevant, mainly in cases when anesthetic and surgical procedures can present failures or difficulties.

Influence of dental chair backrest inclination on the registration of the mandibular position

Varying the inclination of the dental chair backrest might alter the distribution of occlusal contact points. The purpose of this study was to identify the influence of backrest inclination on the registration of the mandibular position. Ten participants aged between 18 and 30 years with a complete permanent dentition, uncompromised motor function, no tooth mobility, and no temporomandibular disorders were selected. To register interocclusal contacts, an autopolymerizing methylmethacrylate device was adapted to the maxillary anterior teeth and a composite resin increment was added to the mandibular central incisors. Contacts were registered with the following variations in the inclination of the dental chair backrest: 90 degrees, 120 degrees, and 180 degrees. A standardized digital photograph was made of each mark in each backrest position, and the images were superimposed to measure the distances in registration from 90 to 120 and from 90 to 180 degrees. Data were analyzed with the Student paired t test (α=.05). When the chair was inclined from the 90-degree to the 120-degree position, the mandible was repositioned posteriorly by a mean of 0.67 mm, but the difference was not statistically significant. When the chair was inclined from the 90-degree to the 180-degree position, however, the mandible was repositioned posteriorly by a statistically significant mean of 1.41 mm. Mandibular position is influenced by increasing inclination, and this influence was statistically significant at a 180-degree incline.

Does a mandibular RDP and new maxillary CD improve masticatory efficiency and quality of life in patients with a mandibular Kennedy class I arch?

To evaluate the change in masticatory efficiency and quality of life of patients treated with mandibular Kennedy class I removable partial dentures (RPDs) and maxillary complete dentures at the Department of Dentistry of the Federal University of Rio Grande do Norte. A total of 33 Kennedy class I patients were rehabilitated with maxillary complete dentures, and mandibular RPDs were selected for this non-randomized prospective intervention study. The patients had a mean age of 59.1 years. Masticatory efficiency was evaluated by colorimetric assay using fuchsin capsules. The measurements were conducted at baseline and 2 and 6 months after prosthesis insertion. Quality of life was evaluated using the Oral Health Impact Profile (OHIP-14) at baseline and 6 months after denture insertion. The Kolmogorov-Smirnov normality test was applied. Masticatory efficiency was evaluated by repeated measures ANOVA. Oral health-related quality of life was compared using the paired t test. There was no statistically significant difference in masticatory efficiency after denture insertion (p = 0.101). Significant differences were found (p = 0.010) for oral health-related quality of life. A significant improvement in psychological discomfort (p < 0.01) and psychological disability (p < 0.01) was observed. Mean difference value (95 % confidence interval) was 6.8 (3.8 to 9.7) points, reflecting a low impact of oral health on quality of life, considering the 0-56 range of variation of the OHIP-14 and a Cohen's d of 1.13. According to the results of the present study, rehabilitation with Kennedy class I RPDs and complete dentures did not influence masticatory efficiency but improved oral health-related quality of life. The association between the patient's quality of life and the masticatory efficiency is important for treatment predictability.

Estudo da estabilidade da cirurgia do tipo sagital da mandíbula com vista a correção de deformidades faciais

This research evaluated the surgical stabilily in patients with mandibular prognathism and retrognathism in which was used sagital split technic to correct those detormities. Twelve patients were selected from the clinic of only one experienced surgeon. Six patients presenter a Class III 6 a Class II molar relationship. A comparative cefalometric analysis using linear and angular measurements was performed of pre-surgery, imediate pós-surgery and 1 year follow-up. The following conclusions were obtained. 1 The Dal Pont sagital split technic modified by Epker to correct mandibular prognathisn and retroghnatism is a stable technic and must be indicated to correct those deformities. 2 Small relapses are easily corrected by the post-surgical orthodontic treatment. 3 A small over correction is advised in cases of large mandibular advancements or set bascks. 4 In those cases which a large amount of mandibular retrusion on advancement need to be performed, a combination of maxillary and mandibular surgery should be used. Rigid fixation technic is also indicated in those cases

Mensuração da profundidade da porção lateral da fossa mandibular, em imagens radiográficas da ATM, obtidas pela técnica transcraniana, em pacientes com dentição decídua, mista e permanente

The author has verified the average depth of the mandibular fossa, in the X-ray image, using the oblique lateral transcranial technique from the right and left sides samples of each patient, which included a total of 176 patients, 87 male and 89 female. The patients were in following phases: deciduous dentítion (the patients had only deciduous teeth in the oral cavity or, if they had any permanent teeth, they could not be in occlusion), mixed dentition (the patients presented deciduous and permanent in the oral cavity) and permanent dentition (the patients had only permanent teeth in the oral cavity), until the eruption of the permanent third molars, in the region from São José dos Campos. São Paulo. Brazil. The patients were under treatment at the Dental School. UNESP (São Paulo State University). ln order to measure the depth of the mandibular fossa in millimeters an imaginary line was traced on the X-ray image, perpendicular to the other line that served as a reference, which was traced from the botton part of the articular eminence up to the tympanosquamous fissure. After the data were obtained and put in a data sheet, they underwent statistical analysis. The results showed that, in the average, the depth of the mandibular fossa in masculine sex is non-statistically signíficant larger than what was observed in feminíne sex, and the right side is larger than the left side, with significant statistical differences. However, only in permanent dentition, in masculine sex, the depth of the mandibular fossa on the right side is larger than on the left side with significant statistical differences

Estudo da assimetria da fossa mandibular, em crânios secos de crianças pelo método radiográfico

The Temporomandibular Joint is a noble structure of the complex mandibular, a lot of research was conducted on the to signs and symptoms of the alterations that attack those structures. ln spite of the high incidence of the DTM in children, there's little knowledge about it, wich makes difficult the treatment Desorders Craniomandibulares (DCM) or Desorders Temporomandibulars (DTM). The Temporomandibular Joint is composed basically by three elements: bones, muscles and disk, in relation to bony part, we have the fossae mandibular that is part of the temporary bone and wich houses the condyle mandibular, accomplishing the articulation among the cranium and the jaw (it leaves piece of furniture of the articulation). Our intention in that work was of verifying a possible asymmetry of the fossae mandibular on the left side and of the right side in relation to two straight line: a straight line that coincided with the plane medium sagittal and another perpendicular straight line to the plan medium sagittal. Analyzing, the fossae mandibular in 91 dry craniums of children, with age varying between four months of life intrauterina and five years, in x-rays in that the incidence was cranium-flow, we could end that: in spite of we find statistical significance in relation to that asymmetry, clinic cannot affirm that interferences on occlusion exists for that asymmetry

Trauma traqueal associado à fratura mandibular: relato de caso

Introduction: The mandibular injuries account for about 20% to 50% of cases of facial fractures. Some consider the jaw the second most commonly fractured bone of the skull, and is the only mobile bone of the facial framework, which results in decreased stability compared to the trauma. When one takes into account the degree of airway obstruction in patients with facial fractures, the problem becomes much more serious since it is one of the most troubling complications of trauma. Objective: the relevance of the topic is aimed to report a case of a patient victim of mandibular fracture associated with trauma to the trachea. Case report: Case report: Patient 24 years old patient with tracheal trauma concomitant mandibular fracture surgically treated in conjunction with the thoracic surgeon. After 5 months postoperatively, the patient is in good condition general, no complaints. Final comments: This form is observed that the key to proper treatment of tracheal trauma associated with facial fractures is the knowledge of the type of injury, and an accurate diagnosis multidisciplinary.

Reabsorção condilar progressiva: revisão de literatura

The progressive condylar resorption is a irreversible complication that can result in malocclusion and facial deformity that can happen especially in postoperative orthognathic surgery of mandibular advancement or combined surgery. Predominantly affect young women, bearers of malocclusions of skeletal class II and with incidence of temporomandibular disorders prior to surgical treatment. Its exact etiology and pathogenesis remain unclear. The purpose of this article is to make a literature review of the last 10 years on the progressive condylar resorption. For this, we used the Medline database for articles in the English language. Then, 13 articles were found, evaluated and compared on predisposing factors, etiology, diagnosis and clinical management.

Reconstrução imediata de fenestração peri-implantar com enxerto autógeno em bloco de ramo mandibular

Alveolar wall fenestrations are common during implant placement. The aim of this paper is to report a case where a peri-implant bone fenestration was reconstructed immediately after implant placement by an autogenous mandibular bone block. A male patient was referred to the Department of Surgical and Integrated Clinics to substitute his Kennedy´s Class IV removable partial denture for an implantsupported fixed prosthesis. A peri-implant bone fenestration at the buccal wall was seen at the region of 12, being reconstructed by a mandibular bone block secured by a bicortical screw. Six months later the surgical procedures, an implant-supported complete fixed partial prosthesis was developed. The autogenous bone block harvested from the mandibular ramus was a safe alternative to reconstruct the peri-implant bone defect such as fenestration types.